Live Annual Conference/symposium Agreement
Agreement type: ------------------------------ The OCME sponsors the CME activity in conjunction with a non-affiliated
organization outside of Downstate wherein the outside entity is responsible for coordinating the activity details. The OCME
ensures that the accreditation criteria are met for certification of CME credit for the activity. (In compliance with the ACCME,
the OCME may audit any activity it certifies for CME credit, regardless of the geographic location of the activity. Travel
expenses for the audit will be covered by the joint sponsor coordinating the activity.)
This is an agreement between SUNY Downstate Office of Continuing Medical Education Columbia University
Department of Medicine for CME certification of the activity entitled ”---------------------- ” on ------------------ at the --------------------------------------To be in compliance with the Accreditation Council for Continuing Medical Education (ACCME), all Activity Directors must
comply with the mission of the Office of CME at SUNY Downstate Medical Center and the AMA’s definition of CME.
Continued approval for category 1 certification depends on the following conditions:
1.

Documentation of needs assessment and professional practice gap must be part of planning and attached to the CME
Application and sent to our office. Measurable educational objectives must be stated. The objectives should relate to
the need and tell participants what they will learn by attending the program. A plan evaluation process must also be
submitted.
2. Speaker Disclosure by all individuals who are in a position to control the content of an educational activity discloses all relevant
financial relationships with any commercial interest within the past 12months. This includes, but is not limited to: activity medical
directors, planning committee members, expert/peer reviewers, authors, faculty/speaker/presenters, moderators, panel members, and
administrative support staff. Any individual who refuses to disclose relevant financial relationships will be disqualified from being a
planning committee member, a faculty/speaker/presenter, or an author of CME program, and cannot have control of, or responsibility
for, the development, management, presentation or evaluation of the activity. Products or procedures being discussed that are offlabel, unlabeled, experimental, and/or investigational and not FDA approved must be disclosed. Including any limitations on the
information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or
unsupported opinion. A commercial interest is any entity producing, marketing, re‐selling, or distributing health care goods or
services consumed by, or used on, patients.
3.
A Budget Plan must be filled out and returned with the CME Application. All anticipated income and expenses,
including the OCME fee must be disclosed. A Final Budget reconciliation must provided within 30 days following
the end of the activity. All commercial support funds must be accounted for.
4.
Commercial Support - see OCME policy for commercial support
a. A Commercial Support Form must be filled out if a commercial organization provides funding of any sort
to the program. The form must be signed by the company representative and the Activity Director and
returned to the OCME for the CME Director signature.
b. All commercial support funds are to be paid directly to the OCME or to the Department sponsoring the
program. Speakers may NOT be paid directly from commercial companies for any related expenses to the
program. This includes travel, honorarium, etc. A 20% fee of the total grant amount is charge to
administer all grants.
5.
Any audio or video of the program for later distribution must be approved by the Office of CME. Additional fees
will be applied.
6. The Activity Director must assure that the activity is HIPAA Compliant and agree to obtain all necessary copyright
permission(s) for any portion of the CME activity materials that is not their original work.
7.
Program Announcement
a. Brochures and announcement material should have the statement of need, educational objectives and the
intended physician audience.
b. You may not indicate on the brochure or flyer that you have applied for certification or state the number of
certifications applied for until the Office of CME has issued approval.
c. The Office of Continuing Medical Education at Downstate Medical Center as the accredited provider may be
displayed as the SPONSOR on the front of the brochure or flyer and your department as the PRESENTER of the
activity not the commercial supporter.
d. The educational format and course outline must be defined on the brochure.
e. Registration fee and location of the activity must be present; f. Acknowledgement of any type of support by
commercial companies must be listed on the activity announcement and/or brochure.
g. The Final Draft of the brochure must be reviewed and approved by the OCME before printing.
h.
The following Statements must appear on all distributed CME activity brochures and flyers.
Accreditation & Credit Designation Statement (as is, with two separate paragraphs and the phrase “AMA PRA Category 1
Credit(s) TM.” italicized):
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation
Council for Continuing Medical Education through the joint sponsorship of SUNY Downstate Medical Center, and Columbia
Dept. Of Medicine. The State University of New York (SUNY) Downstate Medical Center is accredited by the Accreditation
Council for Continuing Medical Education to provide continuing medical education for physicians.
SUNY Downstate Medical Center designates this live activity for a maximum of 7 AMA PRA Category 1 credits™. Physicians
should only claim credit commensurate with the extent of their participation in the activity.
Disclosure Statement
SUNY Downstate Medical Center Office of CME (OCME) and its affiliates are committed to providing educational
activities that are objective, balanced and as free of bias as possible. The OCME has established policies that will identify
and resolve all conflicts of interest prior to this educational activity. All participating faculty are expected to disclose to
the audience, verbally or in writing, any commercial relationships that might be perceived as a real or apparent conflict of
interest related to the content of their presentations, and unlabeled/unapproved uses of drugs and devices. Detailed
disclosures will be made verbally and/or in writing during the program.
ADA Statement
Special Needs: In accordance with the Americans with Disabilities Act, SUNY Downstate Medical Center seeks to make
this conference accessible to all. If you have a disability which might require special accommodations, please contact....
or e-mail your needs to:…
8. HVSA is responsible for submitting all of the above in addition to collecting participants’ evaluations, attendance sheets
and a Final Budget Form to the Office of CME. Certificates of Attendance will be mailed to activity participants listed on the
attendance sheets by the Office of CME.
9.
The fee for this live annual conference is $1, 500. No additional service requested from the OCME. CME certificates are
$20 per person, please inform your participants if you elect not to pay for certificates. If all required documentation has
not being forward to the OCME, there will be no refunds be given once the activity takes place.
The OCME will provide:

Approval of the CME application in timely manner;

Processing and distribution of CME certificates

Analysis of participant evaluation

Summary of Faculty Disclosure for audience
The Activity Director agrees that:

The planned activity will conform to the AMA’s definition of CME, “CME consists of educational activities that
serve to maintain, develop, or increase the knowledge, skills and professional performance and relationships a
physician uses to provide services for patients, the public, or the profession.”

The content or format of the CME activity or its related materials will promote improvements or quality in
healthcare and not a specific proprietary business interest of a commercial interest.

Presentations and activity materials will give a balanced view of therapeutic options.

Use of generic names will contribute to this impartiality. If the CME educational materials or content includes trade
names, where available, trade names from several companies will be used, not just trade names from a single
company.

Comply with Commercial support policy , maintain control over the program content and selection of faculty
members;

Ensure that proper disclosure are made by all program participants including members of the planning committee
PLEASE SIGN AND RETURN WITH YOUR CERTIFICATION REQUEST FORM.
As the Activity Director for the CME Activity titled: 3rd Hypertension Annual Hypertension Conference”. I have read and
understand the essential requirements for Category I credit approval listed on the Annual Conference Policy & Procedure and
agree to forward all the required documentation.
CME Activity Director Signature
Return signed form to OCME and keep a copy for your file.
Date